While the number of deaths from COVID-19 has dropped dramatically from its previous peak, U.S. health care providers still face another national emergency. It’s a hospital error that kills an estimated 150,000 patients annually.

Doctors and hospital administrators increasingly say that full acceptance of air safety principles is likely to be a big part of any solution. But many are rethinking how to make these efforts more viable than ever.

Long before COVID-19 devastated millions of families and thousands of doctors and nurses were pushed to a breaking point, healthcare leaders began to take advantage of the airline industry’s impressive safety record. I was learning and trying to reduce the prevalence of surgical and other medical errors. With the current increased stress on medical staff, supply chains, and safety measures, developing a new vision to re-evaluate the application of aviation practices to address fatal medical errors is an imperative. It seems more important than ever.

Recent evidence shows that hospital-wide safety has declined since the outbreak of the pandemic. A Centers for Disease Control and Prevention study of more than 2,900 hospitals found a significant increase in intravenous catheter-related bloodstream infections in his three months of 2020 compared to the same quarter in 2019. It became clear that there is Another study of 148 HCA healthcare hospitals saw a spike in various treatment-related infections from March to September 2020.

Domestic scheduled airlines have carried more than 8 billion passengers in the last 13 years without a passenger dying. This is an amazing feat that exceeds expectations. In contrast, US hospital failures needlessly cost the lives of an estimated 400 patients each day, the equivalent of a full jumbo jet crashing every 24 hours.

What drives this discrepancy? Veteran leaders in both fields say healthcare struggles to fully understand and translate aviation safety processes to improve patient safety. Hurdles include reliance on limited technology such as checklists, technical challenges sharing safety data across the industry, and veteran physicians becoming team players alongside junior doctors, nurses, and other hospital staff. include cultural challenges that convince them to act on

Just a few months ago, the inspector general of the Department of Health and Human Services said that improvements in hospital safety had generally stalled, and that the rate of Medicare patients suffering preventable harm or serious complications was up from 2008. concluded that it is practically the same as the year.

Three strategies to improve safety

Experts point out that healthcare has not fully embraced three fundamental strategies that airlines and their federal regulators rely on. Rapid and widespread dissemination of information on life-threatening hazards. User-friendly equipment design aimed at preventing repetition of the same fatal error.

In response, discussions have escalated about how to better incorporate such lessons from our Capitol Hill offices to our hospital boardrooms. One example is the emerging debate about creating a National Patient Safety Board modeled on the National Transportation Safety Board (NTSB) to investigate aviation accidents and make public safety recommendations. Such entities can provide a framework for collecting and disseminating critical data about medical malpractice.

The systemic missteps in hospital safety were highlighted by the Institute of Medicine’s seminal 1999 report, “To Err is Human,” which sparked the modern patient safety movement. Over the next two decades, Atul Gawande’s internationally acclaimed book checklist manifestand subsequent publications popularized a series of aviation-derived safeguards.

But healthcare needs to move beyond these early stages. Mimicking aviation procedures first developed decades ago, the overemphasis on medical checklists often prevents reliance on newer, more effective safety technologies. According to Raj Ratwani, director of MedStar Health’s National Center for Human Factors in Healthcare, the usefulness of checklists in healthcare is overrated. After adopting them first over other safety practices, physicians and hospital administrators opted for more sophisticated safety tools, including robust data sharing, enhanced teamwork, and greater responsibility for junior staff. .

non-punitive reporting

Non-punitive accident reporting and rapid distribution of details about dangerous “near misses” have revolutionized modern aviation safety. However, institutional opposition and fear of management retaliation too often stall these concepts in the hospital setting.

According to David Mayer, director of safety research at Maryland-based MedStar Health, applying aggressive aviation safety measures “in nearly all medical specialties” will help “reduce the number of fatalities. The progress of the decline is very slow.” “We’re not quite where aviation is yet when it comes to admitting and documenting mistakes,” he says.

Former NTSB Chairman Christopher Hart explains it more bluntly. “Information sharing in healthcare is pathetic compared to aviation.”

“We need a major cultural shift,” says Kathleen Bartholomew, a former nurse and hospital manager, to promote transparency and empower reporting of treatment errors. “Nurses keep getting fired for bringing up safety concerns,” she adds, but doctors are often reluctant to criticize their colleagues.

In the recent trial of former Tennessee nurse LaDonda Vogt, who was convicted of two felonies for a fatal medication error, safety reporting thwarting made national news headlines. Various health care organizations, such as the American Nurses Association and the American Hospital Association, have expressed concern that the criminalization of treatment errors will further impede voluntary reporting and data sharing. observed.)

data sharing

Medicine already has hundreds of national and state registries that collect data on patient outcomes, complications, and best practices. All of them are confidential and protected from legal discovery. In theory, this model is similar to Aviation Safety Reporting.

However, unlike aviation, there is no comprehensive database intended to prevent errors in hospitals. Information is often contained in digital silos and poorly communicated with each other, if at all. Incident data is typically used by governments to financially punish hospitals for safety negligence, but only after a problem has occurred. This prevents timely disclosure of errors and limits opportunities for ambitious data mining to uncover precursors, root causes, and key takeaways.

There is generally a lack of urgent recommendations that other healthcare providers can readily adopt. Instead, medical feedback loops are primarily focused on reporting the incidence of adverse events. Without more thorough, voluntary reporting and deeper data analysis, hospitals will likely find it difficult to implement effective and sustainable safety programs, experts say.

Easy-to-use medical equipment and technology

Moreover, healthcare has not followed the precedent of the aviation industry in embracing human-centric technology. Modern jet airliner cockpits are designed to ensure that the automation utilized by the aircraft is user-friendly and is evaluated before and after the aircraft is in service. So far, the principle has not been widely disseminated in the operating room or other clinical settings.

Hart, a board member of the joint committee that accredits hospitals, said “human factors experts” “not only design equipment, they design processes” to avoid human error. increase.

Combining easier-to-use medical devices with advanced electronic health records and predictive analytics can dramatically improve patient safety. The potential benefits could be similar to how highly integrated cockpits and detailed data analytics have improved airline safety since the late 1990s.

At this point, most hospitals have resorted to software designed to prevent accidentally overdosing medications on infants or providing adult patients with medications they should never take together. depends. Another safety measure is the need to equip different brands of equipment, such as defibrillators and infusion pumps, with switches and control knobs of a common design to prevent staff confusion that can lead to serious mistakes. I have.

Aircraft manufacturers and equipment suppliers want to use artificial intelligence to identify emerging hazards. For example, proposed safeguards include autonomously locating airports, conducting critical radio communications, actually landing aircraft, and taxiing if pilot behavior suggests disruption or incapacitation. It includes a system that allows you to safely stop on the road. Without human intervention, future cockpits could perform emergency maneuvers to prevent fatal stalls and avoid collisions with other aircraft, mountains, and even man-made obstacles.

Eric Horvitz, Microsoft’s chief scientific officer, says the path could unlock innovation in “the sleeping giant of healthcare.” Tech companies and hospitals are already deploying solutions to identify patients most likely to get worse or develop complications.

Advocates of artificial intelligence (AI) are making it possible for some pilots to review digital and video replays of their performance immediately after completing a flight and compare it to that of other pilots in existing aviation. It also points to technology. Similarly, certain robot-assisted surgical systems use algorithms based on previous procedures to help surgeons move controls more smoothly. A growing number of hospitals are also using AI networks to identify patients in emergency departments and intensive care units who are most at risk of stroke and other life-threatening conditions.

But even here, medicine seems to lag far behind aviation. Aircraft manufacturers have already devised cockpit features that can predict pilot reactions and unilaterally take over flight control systems in dire situations. However, doctors continue to resist letting his network of computers control decision-making and patient care.

To further complicate matters, while AI-enabled software and devices are touted as time-saving, cost-saving, and more accurate solutions to complex medical procedures, the Food and Drug Administration It’s cracking down on a fledgling initiative fraught with technical and ethical issues. question.

Unless the medical community rethinks how reliable and proven aeronautical principles enhance hospital safety, the status quo portends well-intentioned debates for years to come. However, essential changes may be missing to reduce the tragedy of fatal errors in patients.